Individual
MRS. DANIELA M. WHITESIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
19208 BETTY STOUGH RD, CORNELIUS, NC 28031
(704) 728-9002
Mailing address
19208 BETTY STOUGH RD, CORNELIUS, NC 28031
(704) 728-9002
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
2005-01237
NC
207W00000X
Ophthalmology Physician
23928
SC
208D00000X
General Practice Physician
2005-01237
NC
208D00000X
General Practice Physician
23928
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AA77322326
MEDICARE PTAN
SC
05
—
N01237
—
SC
Enumeration date
08/28/2009
Last updated
03/13/2020
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